Sinclair Lewis’ 1927 novel Elmer Gantry is a satire on fundamentalist religion in 1920s America. The eponymous character is a greedy and debauched womanizer who reinvents himself as an evangelical minister. The Reverend Dr. Elmer Gantry is a carney huckster who weasels himself into becoming the leader of a large Methodist congregation. He organizes crusades against immorality while he himself is amoral. Gantry is an unethical and unprincipled power hungry narcissist who contributes to the downfall, injury and even death of those around him. Lewis’ portrayal of pious hypocrisy and opportunism of fanatical religiosity was denounced from pulpits across the country. The book was banned in Boston and many other cities with official censorship boards. Public libraries and some booksellers refused to stock it and the author was threatened with litigation, jail, injury and even death. The attempts at censorship backfired and the novel quickly went to number one on the fiction bestseller list.

The “religion racket” no longer has the power to determine what we read. Unfortunately, similar groups have gained tremendous sway. The “rehab racket” has erected a scaffold able to remove our constitutionally protected rights and civil liberties not only legally but under the pretense of doing so out of our own best interests. According to Erich Fromm rational authority is based on competence, experience and mutual respect. Irrational authority is often disguised as benevolent paternalism and is designed to perpetuate or intensify conditions of inequality through the use or threat of force, deceptiveness and secretiveness.

This system has unfortunately given power and allowances to unethical individuals who are able to exert control over other individuals under the guise of “treatment” regardless of whether or not those individuals even need it as inherent in the current chronic brain disease model of addiction is the importance of external control.

The Federation of State Physician Health Programs (FSPHP) has has played a large part in this. The FSPHP has operated as an unexamined authority for the past 25-years and contains individuals whose pious hypocrisy and carney hucksterism would make Gantry blush. Everything they have done has been done to benefit themselves and their drug and alcohol assessment, testing and treatment affiliates in the provision of protections, power and profit. The FSPHP has pushed bad practice and policy with no discernible scrutiny or meaningful opposition. The impact of any and all of this has yet to be examined. It needs to be.

In Democracy in America Alexis de Tocqueville (1805-1859) warned that the greatest threat the United States faces is the “tyranny of the majority “and that state power would end up concentrated in a single authority until its citizens were “reduced to nothing better than a flock of timid and industrious animals, of which the government is the shepherd,” noting that the newest incarnation of despotism was likely to be ushered in by the “avowed lover of liberty” who is a “hidden servant of tyranny.” “Written laws exist in America,” he wrote, “and one sees the daily execution of them; but although everything moves regularly, the mover can nowhere be discovered. The hand which directs the social machine is invisible” Today several thousand “legislative rules” and regulations are passed each year silently. The impact of this so-called “regulatory dark matter” is usually unknown until it hits us and such is the case here.

Examining the specific practice and policy that has been pushed by the FSPHP (and ratified by state medical boards and their national organization the Federation of State Medical Boards) reveals a body of false-claims making that is designed to facilitate the systemic use of coercion and threats, removal of due process protections and fundamental rights from physicians (and other health care professionals) and prevent, block and eliminate any evidence of the consequences. This practice and policy collective has created a culture of impunity, immunity and deference that is able to successfully conceal egregious ethical violations and crimes. Uncovering and exposing this wrongdoing is nearly impossible as the gauntlets that have been put in place are multiple and they remain largely unseen. What lies beneath, however, is self-apparent and this system of institutional injustice is undoubtedly a major contributor to the grossly underreported suicide epidemic in the medical profession and the reticence of those who actually need help with substance use and other mental health problems to seek help for those problems. They are afraid an it is as plain-and-simple as that.

The FSPHP has been able to conceal the truth, avoid investigation and prevent punishment for wrongdoing for years and they have done this by systematically and systemically removing themselves from all accountability and all outside inquiry.

Direct and specific questioning appears to be their Achille’s heel as has been seen in the increasing torrent of articles and reports critical of these programs . In a rebuttal to Pauline Anderson’s article “Physician Health Programs: More Harm Than Good?” FSPHP President Doris Gunderson dismissed concerns of fraud and abuse in one fell swoop as “allegations rather than facts” and as second hand anecdotes. Countering allegations of an absence of oversight and regulation she states:

“In fact, we operate under a microscope, answering to individual practitioners, medical boards, malpractice carriers, defense attorneys, state attorneys, medical societies, hospitals, medical schools and residency training programs. We are also accountable to patient safety entities and a Board of Directors.”

Untrue. Accountability demands both provision of information and justification for actions to outside entities capable of punishing misconduct. . What was done and why? No such entity exists and no pathway for appeal or grievance redressal exists either. Zero accountability. Ditto for the “PHP-approved” assessment and treatment centers. As cash only out-of-pocket private facilities they remove themselves from the prying eyes of insurers.

In response to Emmy Award winning P.J. Randhaw’s 2019 investigative journalism piece addressing these issues seen here the FSPHP and its state affiliate would not even respond to direct questioning on these issues. The stance seems to be to ignore these systemic and serious allegations and hope they will go away. They will not go away. Simple and direct questions deserve simple and direct answers and the unwillingness to address the particular and remarkably similar allegations of exceptionally egregious misconduct and fraud is unacceptable. The silence speaks volumes.

The North Carolina PHP Audit found the past FSPHP President and NC PHP director Warren Pendergast could not even identify qualitative or quantitative indicators that are used for “approving” the “PHP-approved” assessment centers. The best justification he could come up with was “reputation” and “word of mouth” yet state medical boards (and other licensing boards) mandate evaluations at these facilities and specifically exclude non-“PHP-approved” facilities.

Denying accusations of coercion Gunderson states in her rebuttal to Anderson’s article:

“The detractors of PHPs interviewed for the article maintain that PHPs are coercive. Yet the report fails to mention that PHPs have no authority to mandate treatment and monitoring, suspend or revoke licensure, or otherwise discipline physicians.”

Legitimate authority articulates ethical, evidence-based, or internally consistent arguments when challenged. Legitimate authority does not simply delegitimize one’s opponent and use logical fallacy and obfuscation to avoid addressing the substance of the argument. In her rebuttal Gunderson claims the North Carolina Audit was favorable because no evidence of abuse was found. This is akin to a serial killer claiming victory because no bodies were found in his dungeon replete with torture devices and restraints. State auditor Beth Woods set this straight when she told the BMJ in Physician Health Programs Under Fire that the holes were big enough in the program “you could drive a truck through them” and it would be “difficult, if not impossible, to defend” oneself against an incorrect assessment” as no ability to “appeal a diagnosis or assessment” existed.

“Compounding the problem, said Wood, was that “the chief executive and medical director were in total control of entire process.” They assessed allegedly impaired doctors, but when those assessments were contested, they were responsible for presenting complaints to the state medical board. The doctors concerned were not allowed to be present and were not allowed to see the programs’ medical reports on them.”

The inability to obtain one’s own medical records or lab reports is the first obstacle one must overcome. The second barrier is that even if documents are obtained there is no one to give them to. The third is the existence of “point people” who deflect, block and otherwise dismiss valid complaints. The only oversight provided to the involved labs is an an accreditation agency, the College of American Pathologists (CAP) They can investigate and correct but do not have the ability to sanction.

Of the many hundreds of doctors I have spoken to and who have taken my survey not one has been able to obtain evidence of abuse. It was either refused, censored or doctored.

Research on street criminals suggests the certainty of punishment has the strongest deterrent effect (basically will I be caught) and the more people think they will be arrested for a crime the less likely they are to commit it.

Criminals weigh their actions against possible gains and consequences and the risk of consequences in this system have been essentially zero. Diagnosis rigging, coercion, threats and abuse are rampant because they have no fear of punishment.

This misconduct that is seen in this racket is comparable to someone who robs a 7-Eleven for $1,000 and never gets caught so then robs as many 7-Elevens as he can for as much as he can and then realizing there is essentially zero chance of getting caught expands the enterprise to robbing as many convenience stores as he can.

This illegitimate authority of self-proclaimed experts has successfully gained power and removed all accountability. Unethical and unprincipled narcissism has unfortunately become the tone at the top.

Tone at the Top

An expectation of irreproachable ethics and honesty ideally sets the bar for leadership in any organization. Without ethical integrity, falsity will flourish.

Adherence to societal and professional ethical codes is a universal obligation. It excludes all exceptions. Good leadership requires correct moral and ethical behavior of both the individual and the organization. Integrity is necessary for establishing relationships of trust. It requires a true heart and an honest soul. People of integrity instinctively do the “right thing” in any and all circumstances.

“Tone at the top” refers to the ethical atmosphere created by an organization’s leadership as it creates an ethical atmosphere that inevitably cascades throughout the organization – for good or for bad as the case may be. A strong tone at the top is essential to ensure strong internal control and effective governance. It requires that upper management lead by example and action. This includes rewarding ethical behavior and punishing misconduct. An ethical tone at the top holds those below accountable for unethical actions and imposes sanction those who do bad things and improper or unethical conduct is not tolerated, condoned or overlooked.

But when those in top positions set the wrong it will inevitably trickle down as those below follow in their leaders fraudulent footsteps. Unprincipled and unethical leaders create unprincipled and unethical followers and this creates an organizational culture that becomes a breeding ground for corrupt practices such as conflicts of interest, self-dealing, illegal activities and abuse. Such a culture places both the viability of the organization and its stakeholders at risk.

In his book Without Conscience, Dr. Robert Hare notes “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society” and Dr. Clive Boddy in Corporate Psychopaths observes that “unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.”

The Federation of State Physician Health Programs (FSPHP) make authoritative pronouncements on professionalism and ethics. In Disruptive Behaviors Among Physicianspast president of the organization Dr. Luis Sanchez pontificates on a “culture of safety“ and promotes “clear expectations and standards.” He calls on leaders in the medical profession to “commit to professional behavior” and to lead by example. But truth is comprehended by examining actions not words. One measure of integrity is truthfulness to words and deeds and by that measure Sanchez, Skipper, Teitelbaum, Pendergast and numerous other self-proclaimed “leaders” of the “physician-wellness” movement fall miserably short.

As with Reverend Dr. Elmer Gantry the carney huckster who weaseled himself into becoming the leader of a large Methodist congregation these individuals have managed to weasel themselves into positions of power and the impact has been far reaching and grave. Organizing crusades against immorality while he himself was amoral the unethical and unprincipled power hungry narcissist Gantry contributed to the downfall, injury and even death of those around him. So too have the pious hypocritical opportunists who have reinvented themselves as experts and authority in this arena and unless courage and resistance steps up the noble profession of medicine will be utterly demolished without a brick standing.

How can we interpret this? Are the prizes not worthy of the time involved in such an endeavor? No, I think there is something for everyone including 2oo volumes of the Classics in Medicine. A current listing on Amazon is listing 187 volumes for almost $5000 and in addition to this I am offering dozens of 1970s skateboards, 2 vintage Schwinn Krate bikes, autographs from polio vaccine pioneers Sabin and Salk, multiple signed and one-of-a-kind items related to Boston politician James Michael Curley, a menu, cocktail menu, matchbook and other very rare items from Boston’s Cocoanut Grove which was the site of the deadliest nightclub fire in history in 1942, signed lithographs and prints from Warhol and Keith Haring and a signed poster from Adam Ant. So the prizes are not chopped liver and burnt toast. The prizes are worthy so in a time or work/benefit analysis the benefits are high. What about the time or work involved? Would the work and time it takes to disprove this claim make it not worth the effort like trying to prove some logic or mathematical theorem? The James Randi Educational Foundation offered 1 million dollars to anyone who could prove that homeopathy works but no one has claimed it yet. Why? Because homeopathy does not work. My challenge is fairly simple as the documents are a quick read and the claims direct and specific. All one has to do is read the documents in search of acts that might be considered crimes and use a legal reference to see if they correspond to criminal code. If your examination of the documents finds everything is on the up-and-up or just one or two acts commensurate with felonies then the prizes are yours. A simple task that should take less than an hour or two. So why is no one knocking at my door? No one is knocking for the same reason the million dollar homeopathy reward hasn’t been claimed. The reason no one is knocking at my door is because Luis Sanchez did in fact commit multiple felonies. I could double the prizes, give you everything I own and offer my very soul but there would still be no one knocking.

So the question for us is this, how is it possible that an individual contracted by a state agency could commit felony crimes that are documented by direct evidence and not be called on it? The crimes include flagrant forensic fraud no different from Annie Dookhan who faked, forged and fabricated some 60,00 samples at the Massachusetts crime lab. Fabricating evidence is fabricating evidence so how is it possible that this fabrication of evidence has not been identified and addressed by anyone? First of all there is no direct oversight or independent oversight to state physician health programs (PHPs). Not one agency exists that can accept a complaint, investigate it and punish offenders. Second, there is an inability or unwillingness to investigate or punish the offenders for various reasons. PHPs have portrayed themselves as allies to law enforcement and have requested they defer to them any issues related to physicians. When crimes are reported to local and state police and other law-enforcement agencies they are deemed the illusory product of a diseased mind. States Attorneys General legally represent occupation board. Policy dictates they side with medical boards so individual doctors are rebuffed if they ask for help. The FBI will not investigate. I was told unless the AGO requested it or a public outcry ensued they would not address any issues regarding physician health programs including laboratory fraud and diagnosis rigging. This inability or unwillingness to meaningfully investigate the offenders is a pervasive problem and represent a total systems failure. No one is minding the minders and no one wants to mind the minders. The agencies that could and should investigate crimes are taking a “not-my-problem” stance. The medical boards have agreed to absolute deference to PHPs and additionally have individuals or groups within the board who are able to block, deflect and otherwise dismiss information implicating the state PHP. All of the documents seen below were provided to Physician Health and Compliance Board counsel Deb Stoller beginning in 20111 but she apparently kept all the documents to herself. Her ethical obligation when being provided with evidence of forensic fraud and other crimes was to notify the proper authorities. She did not. She suppressed all of the information with direct evidence of crimes, an act that is much more grave and vile than Dookhan as the documents show collusion between the MA PHP and one of the drug testing labs used by almost all state PHPs. The documents provide direct evidence of lab fraud and falsification of evidence that is clear and specific. No alternative explanations exist. Concealing this type of misconduct just allows it to continue and what is seen here is not rare. I have heard from many many doctors who claim they were given bogus tests at this very same lab. Sadly I have heard of many suicides related to these very same tests. Faced with the “not my problem” stance of agencies that could and should do something but did not these doctors became hopeless and helpless and killed themselves out of despair. Their locus of control was completely lost and their was no lifeline. Selective application of the law is the root of government corruption and destroys the moral authority of the government. It inevitably leads to collapse and chaos. The Massachusetts Board of Registration in Medicine has ignored these documents for five years and assert that the PHP has not committed any crimes because they have not been charged with any crimes. Nonsense and logical fallacy. The PHP did commit crimes and so too did Board attorney Deb Stoller when she was given direct evidence of them–misprision of a felony in multiples.

The simple fact is that doctors are being subject to diagnostic rigging and forensic fraud and nobody cares. This is by design and fueled by the anti-doctor sentiment spread by these same groups with propaganda meant to spread the bogus dangers of a hidden cadre of drug addled and besotted doctors. It doesn’t exist but the stature of doctors in the public eye has suffered because of the mythology they created. Don’t get me wrong as any doctor with a substance abuse problem or addiction should be removed from practice and not be able to practice until safe to do so. But that is not what is happening here.

The majority of doctors being monitored by state physician health programs do not have a problem. They have loosened the diagnostic criteria so that essentially anyone referred to them is given a diagnosis and treated. Why? Because it is a money maker. All costs are out-of-pocket and no insurance is involved. The “PHP-approved” assessment centers all charge around $ 4500 for an “assessment” which inevitably leads to a 3-month inpatient stay for treatment to the tune of about $80,000. This is then followed by a five-year monitoring contract with random drug and alcohol testing 1-3 x per week. That is a total of 260 to 780 tests and the laboratory developed tests are not cheap. You do the math. The drug and alcohol assessment and testing industry makes a pretty penny off this operation and they want to bring it to you-It is in fact a Trojan horse.

So by ignoring this type of misconduct it will only get worse. People tend not to get concerned unless it impacts them. This will. Someday you or a family member may be in this same situation. It boggles my mind that doctors can be given diagnoses when they do not meet the criteria for the given diagnosis and this is confirmed by outside independent experts. This occurs because those giving the diagnosis have no accountability. They have removed themselves. But in actual fact this is political abuse of psychiatry. It is egregious.

Diagnosing someone with a disease they do not have should be a never event. The perpetrators should not only have their licenses removed but they should be punished for the crime. Forensic fraud should also be a never-event but as seen below it is done without fear of sanction-by fax no less. Giving false diagnoses and fabrication of drug and alcohol tests are actions that should never be tolerated. Not even once. How can this be happening in the United States of America? Unless people speak up this will only escalate. Below is a detailed analysis of the multiple crimes used for the $25,000 challenge. Give it a read and try to disprove the claim that Luis Sanchez committed multiple felonies. If you can you win all the prizes. If you can’t then I ask that you be outraged and do something about it as you or someone you love may be next. Ignoring this type of misconduct is not going to make anything better.

Fraud is distinguished from negligence, ignorance, and error by virtue of the fact that it is intentional. Fraudulent intent is established by examining the documentation of decisions and behaviors of those involved.

Innocent parties don’t normally “update” donor ID numbers or lab reports to “reflect that chain of custody be maintained as requested in the document below faxed from Physician Health Services, Inc. (PHS) to United States Drug Testing Laboratories (USDTL) on July 19th, 2011.

The lab report PHS is referring to is seen below which is positive for the alcohol biomarker phosphatidylethanol at a level of 365.4 ng/ml (cutoff level for a positive test is 20 ng/ml.

Note both the chain of custody and Donor ID # are listed as 461430 and there is no collection date, collectors name or location listed. The specimen was received on July 8, 2011 and reported on July 14, 2011 according to the document. On July 19th, 2011 Mary Howard requests that a collection date of July 1st, 2011 be added and that the Donor ID # be changed from 461430 to #1310.

What is the significance of this? My unique identifier for for random drug and alcohol testing is #1310 and I had this same test drawn on July 1st, 2011.

USDTL “updated” the test. The document below shows they added my ID # and a collection date of July 1, 2011.

It is the responsibility of the Medical Review Officer (MRO) to make the final determination as to whether or not the positive result reported by the laboratory is reported to anyone else.

The previous Medical Director of the Massachusetts PHP, Physicians Health Services, Inc. (PHS) for fourteen years, Dr. Luis Sanchez, is also a past President of the FSPHP although PHS did not enter into formal partnership with the FSPHP until 2013. The Director of Program Operations at PHS, Linda R. Bresnahan, MS, is the current Secretary of the FSPHP.

PHS, inc. exclusive use of out of state treatment programs has been challenged. In the past PHS, Inc. has adamantly refused to allow physicians to be evaluated in State despite it being one of the medical hubs of the country. Physicians in Massachusetts who are referred for evaluation in Kansas, Georgia, Alabama, and West Virginia as PHS has convinced the Board that only these facilities are ‘experienced in the assessment and treatment of health care professionals.” In actual fact the medical directors of all of these preferred facilities are also ASAM physicians with the vast majority being in 12-step “recovery” themselves and a close colleague if not friend of the medical director of the state PHP.

“A body of men holding themselves accountable to nobody ought not to be trusted by anybody.”― Thomas Paine

“Our minds tell us, and history confirms, that the great threat to freedom is the concentration of power. Government is necessary to preserve our freedom, it is an instrument through which we can exercise our freedom; yet by concentrating power in political hands, it is also a threat to freedom. Even though the men who wield this power initially be of good will and even though they be not corrupted by the power they exercise, the power will both attract and form men of a different stamp.”

The “PHP-blueprint” is being promoted as a “new paradigm” with a success rate twice that of other treatment programs (80%). With numbers this high, the argument goes, why bother with anything else? The attached slides are from a presentation Sanchez gave at a legal issues conference. His presents the ACGME definition of professionalism that includes competencies in altruism, accountability, excellence, duty, honor and integrity, and respect for others. Sanchez also addressed these topics in an article he wrote for the Journal of the American Medical Association (JAMA) entitled Disruptive Behaviors Among Physicians. In thiis article he discusses a “medical culture of safety” with “clear expectation and standards.” Sanchez affirms the importance of values and codes-of-conduct in the practice of medicine, and calls on physician leaders to “commit to professional behavior.”

PHS Director of Operations Linda R. Bresnahan has also been involved in leadership positions at the FSPHP including acting a Executive Secretary and Interim Executive Director.

PHPs recommend referral of physicians if there are any concerns such as getting behind on medical records. As PHS Associate DirectorJudith Eaton explains “when something so necessary is not getting done, it is prudent to explore what else might be going on.” If the PHP feels that doctor needs an assessment they will send that doctor to a “PHP-approved” facility “experienced in the assessment and treatment of health care professionals.” The physician must comply with any and all recommendations of the assessment center. To assure this the physician must sign a monitoring contract with the PHP (usually five years). USDTL is one of the labs PHPs have contracted with for forensic drug and alcohol testing.

USDTL drug testing laboratory claims to advance the”Gold Standard in Forensic Toxicology.” “Integrity: Results that you can trust, based on solid science” is listed as a corporate value. “Unlike other laboratories, our drug and alcohol testing begins and ends with strict chain of custody.” “When people’s lives are on the line, we don’t skip steps.” Joseph Jones, Vice President of Laboratory Operations explains the importance of chain-of-custody in this USDTL video presentation.

Forensic Drug and Alcohol Tests: The Need For Integrity and Accountability of the Sample

“Forensic” drug-testing differs from “clinical” drug-testing in how the results are used. “Clinical” tests are used for medical purposes in diagnosing and treating a patient.

A “forensic” test is used for non-medical purposes. It is not used for patient care, but for detecting licit and illicit substances in those who should not be using them. Pre-employment and employee assistance and professional monitoring programs are examples.

Forensic testing is held to a higher standards because the consequences of a positive result can be grave and far reaching. A positive forensic test can result in loss of rights of the individual being tested and his or her loved ones. Mistakes are unacceptable.

Any and all drug testing requires chain-of-custody. The custody-and-control form is given the status of a legal document because it has the ability to invalidate a test that lacks complete information. Chain-of-custody provides assures specimen integrity. It provides accountability.

The job of the MRO is to ensure that the drug testing process is followed to the letter and reviews the Custody and Control form for accuracy. The MRO also rules out any other possible explanations for a positive test (such as legitimately prescribed medications). Only then is the test reported as positive.

“the sole responsibility of the MRO is to”ensure that his or her involvement in the review and interpretation of results is consistent with the regulations and will be forensically and scientifically supportable.”

“Fatal flaws” such as lack of chain-of-custody form, missing tamper proof seal, missing signatures, or a mismatch of the sample ID and chain of custody ID invalidate the test. It is not reported. Tight chain-of-custody and MRO review is critical for the accountability and integrity of the sample.

The Medical Review Officer Certification Council provides a certification process for MROs. Theyalso follow their own Code of Ethics. In accordance with these standards PHS has an MRO to review all positive tests. As added assurance the FSPHP guidelines state that all positive tests must be approved by the Medical Director.

Regulation and the Medical Profession–The need for Integrity and Accountability in Physician Leadership and Health Care Policy.

The July 19th, 2011 fax from PHS seen below is in reference to the lab report from USDTL seen above. In it PHS requests the report be “updated”to donor ID number “1310” and to “reflect that the chain of custody was maintained.”

The lab report is a positive test for the alcohol biomarker (Phosphatidyl Ethanol) or PEth, an alcohol biomarker introduced by the Federation of State Physician Health programs and marketed by USDTL and other labs to detect covert alcohol use..

There is no record of where, when or by whom it was collected.

Both the donor ID # and chain of custody are listed as 461430.

The purpose of chain-of-custody is to document the location of a specimen in real time. “Updating” it is not an option. It is prohibited. Updating the “chain of custody to reflect that chain of custody was maintained” is a clear indicator that it was not maintained.

ID #1310 is the unique identifier I was issued by PHS. It is used as a unique identifier, just like a name or social security number, to link me to any sample collected for random drug and alcohol screening. #1310 identifies me as me in the chain-of-custody. On July 1st, 2011 I had a blood test collected at Quest Diagnostics.

The sample was collected at Quest Diagnostics on July 1, 2011 but these documents were not obtained until December 3, 2011 and were included in the “litigation packet” which documents chain-of-custody and is generated on any and all forensic drug testing. It provides proof that the test was done on who it was supposed to have been done and that all required procedure and protocol was followed. It protects the donor form being falsely accused of illicit substance use. In most employee drug-testing programs the litigation-packet is provided on request immediately. It is a transparent process. This is not the case, however, at PHS.

I requested the litigation packet immediately after the positive test was reported on July 19, 2011. PHS first refused, then tried to dissuade me. They finally agreed but warned there would be “unintended consequences. The entire litigation packet can be seen here: Litigation Packet 12:3:2011

The positive sample has no chain-of-custody linked to me, no date, and no indication where it was collected or who collected it. In addition there was no “external” chain of custody for the sample. The custody-and-control form was missing.

With multiple fatal flaws (6/6) rendering it invalid, USDTL should have rejected it by their own written protocol.

USDTL did not reject it. The document below shows that USDTL added my ID # 1310 and added a collection date of July 1, 2011–the day I submitted the sample.

“REVISED REPORT PER CLIENTS REQUEST”

And in doing so the lab that claims “integrity” and “strict chain of custody” readily, and with no apparent compunction” manufactured a chain-of-custody and added a unique identifier by faxed request.

The litigation packet was signed by Joseph Jones on December 3, 2011. There was no record of where the sample was from July 1st to July 8, 2011. No external chain-of-custody or custody-and-control form was evident in the litigation packet.

The V.P. for Laboratory operations for the lab that claims “strict chain of custody” and that “doesn’t skip steps” “when “peoples lives are on the line” verified a positive test as positive with no custody and control form, no external chain of custody and 6/6 fatal flaws. What is so shocking is that this was done without compunction or pause. As a forensic test ordered by a monitoring program Jones knew full well it would result in significant consequences for someone. He knew that someones “life was on the line,” knew it was wrong, and did it anyway.

A person of conscience would never do this. It is unethical decision making that goes against professional and societal norms. A “moral disengagement” that represents a lack of empathy and a callous disregard for others. I would not consider doing something like this for any price and here it appears to be standard operating procedure.

Expecting to be diagnosed with a non-existent problem and admitted for non-needed treatment I requested an evaluation at a non-12 step facility with no conflicts-of-interest. Both PHS and the Medical Board refused this request in one of four violations of the Establishment Clause of the 1st amendment.

I chose Hazelden. The Medical Director was aware that I had just signed a patent license agreement for an epinephrine auto-injector and he had a child with a peanut allergy. We talked about the device and discussed the problems with current management. I think it was because of this added personal interaction that he did not “tailor my diagnosis” as PHS most certainly requested. Seeing me as a person rather than an object, I believe, enabled his conscience to reject it. My discharge diagnosis found no history of alcohol issues but they could not explain the positive test. Unable to rule out that I drank in violation of my PHS contract they recommended I attend AA.

PHS mandated that I attend 3 12-step meetings per week and requested that I obtain names and phone numbers of fellow attendees so they could contact them to verify my attendance. They also mandated that I discontinue my asthma inhalers (as the propellant contains small amounts of ethanol) that had been controlling my asthma and preventing serious attacks for the previous ten years. I was threatened that if I had to use the inhalers or one day late on the increased payments I would be reported to the Board and lose my license.

Sanchez states that my request for the “litigation packet” was processed on December 5, 2011 (two days after Jones signed off on it) and adds the “testing laboratory is willing to support the test results.”

In the interim I filed a complaint with the College of American Pathologists. I also requested the missing external chain of custody documents from Quest.

I never received the chain of custody from Quest. Instead I received a letter from Nina Tobin, Compliance Manager for Quest documenting all the errors but written to sound as if some sort of protocol was maintained. Tobin claimed the specimen was inadvertently logged as a clinical specimen but sent on to USDTL a week later. (See Quest Letter )

The Chief of Toxicology at MGH wrote a letter to the Board documenting all of the misconduct and irregularities stating that it was an “intentional act” perpetrated by PHS. MLLv3finalJacob_Hafter_Esq_copy.

I was subsequently reported as “non-compliant” with AA meetings. They could not give any details of where or when. They then misrepresented a declaration of fact (I stated that I had started going to a specific meeting on a specific date) as an admission of guilt by saying I was referring to a different meeting. 10:23:12 PHS Letter to BORM-noncompliance.

My Chief at MGH, his Chief and others held a conference with PHS and attempted to remove me from PHS and replace the monitoring contract with one of their own. They refused. When confronted with the fabricated test they dismissed it and focused on sending me to Kansas to one of the “disruptive physician” Psikhuskas where they are using polygraphs (despite the AMAs stance that it is junk science) and non-validated neuropsychological instruments that detect “character defects” to pathologize the normal.

I refused. Had I gone to Kansas I would have been given a false diagnosis and my career would be over. This is what they do.

Amy Daniels, the investigator for the College of American Pathologists contacted me in December of 2012 to see how things were going since USDTL “amended” the test. Daniels told me that the College of American Pathologists confirmed my allegations and, as an Accrediting Agency for Forensic Toxicology mandated that USDTL correct it. (Labs can lose accreditation if they do not comply with CAP Standards for Forensic Drug Testing). This was done on October 4, 2012.

PHS denied any knowledge of an amended test. I also wrote an e-mail to Joseph Jones requesting the document but he did not reply.

I contacted CAP. On December 11, 2012 Dr. Luis Sanchez wrote a letter stating “Yesterday, December 10 2012, Physician Health Services (PHS) received a revision to a laboratory test result”

“The amended report indicates that the external chain of custody protocol [for that sample] was not followed per standard protocol]”

Sanchez dismisses this test as irrelevant, rationalizing neither PHS nor the Board based any actions on the test and they would “continue to disregard” it.

The logic is that it was my behavior that resulted in any consequences. My “non-compliance” in October led to my suspension and the test had nothing to do with it. The sole reason for reporting me to the Board in 2011 was the positive test. There is no other pretext to use. It is misattribution of blame as without the test, now invalidated, there would have been no AA meetings to say I was non-compliant with.

In response to a civil complaint PHS, Quest and USDTL all took the position that the results of the fraudulent testing had absolutely nothing to do with anything.

And in response to the allegations of forensic fraud the labs claimed there was no forensic fraud because this was not a “Forensic” test but a “clinical” test. The argument was that “clinical” tests do not require chain-of-custody and it was his behavior not these tests that resulted in consequences.

As a “clinical” test I knew it was considered Protected Health Information (PHI) under the HIPAA-Privacy Rule. A patient must give written consent for any outside entities to see it. Obtaining lab tests previously required the consent of both the patient and the ordering provider. What PHS and the labs were apparently unaware of was the changes to the HIPAA-Privacy rule giving patients increased rights to access their PHI. The changes removed the ordering provider requirements. A patient has a right to obtain lab test results directly from the labs and has 30 days to do it. CAP agreed. USDTL sent me all of the documents. They can be seen below:

1. The e-mail from me to Joseph Jones dated December 10, 2012. It can be seen on page 22 of the USDTL documents.

2. USDTL document confirming PHS knew the test was amended 67-days before they said they did.

The document shows PHS and Sanchez were aware of the invalidity of the test on October 4, 2012. Instead of correcting things they initiated machinations to throw me under the bus. They officially reported me to the Board for non-compliance on October 19, 2012.

The December 11, 2012 letter signed by Sanchez states “Yesterday, December 10, 2012, PHS received a “revised report” regarding the test. The documents show he knew about it 67-days prior.

Although USDTL complied with the HIPAA-Privacy Rule and CAP, Quest did not. Quest Diagnostics refused to send me copies of their lab reports claiming it was confidential and protected information that required PHS consent. Quest required I sign a consent form with multiple stipulations regarding PHS. I refused and contacted the Department of Justice -Office of Civil Rights. The DOJ-OCR agreed with me and I received the Quest documents

Remember a “clinical” test can only be ordered by a physician in the course of medical treatment. It requires authorization from the patient to obtain a “clinical” specimen and it requires written authorization as to who sees it. Referring physician was Mary Howard.

And below is the fax from PHS to Quest from July 1, 2011 also requested by Mary Howard. The signature on the front is not mine. In addition I gave the blood at 9:30 and was in my clinic at MGH at 12:23 so it couldn’t be. The WC 461430 R are dated July 2, 2011. This is a “clinical” not “forensic” sticker. The “R” indicates a red top tube. The other sticker is USDTL and indicates it was logged in on July 8, 2011.

What does it all mean? Blood left in a red top tube ferments. This is basic chemistry. The PEth test needs to be refrigerated and shipped overnight to prevent this. In addition it needs to be collected with a non-alcohol wipe in a tube that has an anti-coagulant or preservative so that it does not ferment. It requires strict procedure and protocol.

When I gave my blood on July 1st, 2011 it was as a “forensic” test per my contractual agreement with PHS.

On July 2, 2011 it was changed to “clinical.” Why? because “forensic” protocol would have invalidated it.

The only conceivable reason for doing this was to bypass chain-of-custody procedures. My unique identifier #1310 was removed and the clinical specimen number was used for chain-of-custody. The R in 461430R indicates a red top tube.

By holding on to it for one week the blood fermented. As it was July with an average temperature close to 90 they overshot their mark a bit. My level of 365 is consistent with heavy alcohol use–end stage half-gallon a day type drinking.

Quest then forwarded it to USDTL with specific instructions to process it as a “clinical” sample. USDTL complied and processed it as a clinical specimen which was reported it to PHS on July 14, 2011.

PHS then asked USDTL to add my forensic ID # 1310 and add a collection date of July 1, 2011 so it would appear “forensic” protocol was followed. The reason Jones signed the “litigation packet” on December 3, 2011 was because that was when the “litigation packet” was manufactured. A “clinical” sample does not produce one.

USDTL willingly complied with this request.

PHS then reported this as a “forensic” test to the Medical Board on July 19, 2011 and requested a reevaluation.

The distinction between “forensic” and “clinical” drug and alcohol testing is black and white. PHS is a monitoring program not a treatment provider. The fact that a monitoring agency with an MRO asked the lab to process and report it as a clinical sample and then used it forensically is an extreme outlier in terms of forensic fraud. The fact that they collected it forensically, removed the forensic components and let it sit in a warehouse for a week is abhorrent. The fact they then specifically requested it be processed as a clinical sample deepens the malice. The fact that they then reported it to the Board as a forensic sample and maintained it was forensic up until just recently makes it egregious. But the fact that the test was changed from “positive” to “invalid” on October 4th, 2012 and they then reported me to the Board on October 8th, 2012 for “noncompliance,” suppressed it and tried to send me to Kansas where I would be given a non-existent diagnosis to delegitimize me for damage control makes it wantonly egregious. This is political abuse of psychiatry.

Accountability requires both the provision of information and justification of what was done.

For doctors it is very difficult to obtain the information. As seen here, they put up a gauntlet to prevent the provision of what is immediate in all other drug testing programs. I now have all of the information. What it shows is clear. This was intentional. It was no accident. They knew what they were doing, knew it was wrong but did it anyway.

Accountability also requires that those who commit misconduct suffer consequences. The PHPs have also put up barriers to this. With no regulation or oversight they have no apparent accountability.

My understanding is that it works this way. The Medical Board, Medical Society and Departments of Public Health have no oversight. The MMS has an ethics committee but all they can do is “educate” the person if they feel there was a violation. The DPH won’t even look at it and the Board is complicit.

My understanding is that they have convinced law enforcement that this is a “parochial” issue that is best kept within the medical community. They have also created the impression that they are “friends” of law enforcement. I have heard from many doctors that they have tried to report misconduct, civil rights violations and crimes to the police, AGO, and other law enforcement agencies only to be turned back over to the PHP. By saying the physician is “impaired” it delegitimizes and invalidates the truth. “He’s just a sick doctor, we’ll take care of him.” That physician then suffers consequences effectively silencing the rest.

PHS uses the Board to enforce punitive measures and temporize. The Board puts blind faith in PHS. Blind faith that defies common sense ( mandating phone numbers at anonymous meetings) and disregards the law (Establishment Clause violations that are clear and well established). The Board also temporizes to cause damage.

In my case they required a psychiatric behavioral evaluation. I was given the choice of Kansas and a few other Like-minded assessment centers.

After petitioning for multiple qualified psychiatrists that were summarily rejected months later for no reason one of the Board Attorneys suggested Dr. Patricia Recupero, M.D., J.D. who is Board Certified in Forensic Psychiatry and Addiction Psychiatry. The Board had used her in the past but not recently. Seeing that she had been used by the Board for fit-for-duty evaluations in the past the Board accepted my petition.

Dr. Recupero wrote an 87-page report. She concluded I was safe to practice medicine without supervision, that I had never had an alcohol use, abuse or dependence problem, and that PHS request for phone numbers was inappropriate. She also documented PHS misconduct throughout my contract and concluded it was PHS actions, not mine, that led to my suspension. What she describes is consistent with criminal harassment. She documents the falsification of neuropsychological tests and confirms the forensic fraud. What did the Board do? Ignored their very own recommended and approved evaluator.

One measure of integrity is truthfulness to words and deeds. These people claim professionalism, ethics and integrity. The documents show otherwise. The careers and lives of doctors are in these peoples hands.

Similar fraud is occurring across the country. This is an example of the institutional injustice that is killing physicians. Finding themselves entrapped with no way out, helpless and hopeless they are feeling themselves bereft of any shade of justice and killing themselves. These are nothing more than bullies and accountability is essential. The “disruptive physician” moral panic has harmed the Medical Profession.

Dr. Clive Body in his book Corporate Psychopaths writes that “Unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.” And according to Dr. Robert Hare in Without Conscience “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ”

Wes Boyd notes that valid complaints from physicians are often dismissed as “bellyaching” by the PHPs. Complacent that these are just good guys helping doctors and protecting the public the complaints are dismissed, tabled, deflected or otherwise ignored. Bellyaching?? Is this bellyaching.

It is my opinion that what you see here is indefensible Procedurally, Ethically, and Legally.

Procedurally it goes beyond negligence and represents fraud. It violates every procedural guideline, regulation and standard of care including their very own.

Ethically it violates everything from the Hippocratic Oath to AMA Medical Ethics to the MRO Code of Conduct.

And where was PHS MRO Wayne Gavryck? By my count he violated at least 4 of the 6 Codes of Ethical Conduct.

What was done here violates the most fundamental ethical principles of Medicine -Autonomy, Beneficence, Nonmaleficence and justice.

Intentionally falsifying a laboratory or diagnostic test to refer for an evaluation or support a diagnosis or give unwarranted “treatment” is unconscionable. Abuse under the utility of medical coloration is especially egregious.

The information provided herein should negate any “peer-review” protection or immunity afforded PHS as it is undeniably and egregiously in “bad faith.” Moreover, the ordering a “clinical” test is outside PHS scope, practice, and function of PHS. According to M.G.L. c. 111, § 203 (c):

An individual or institution, including a licensed or public hospital, physician credentialing verification service operated by a society or organization of medical professionals for the purpose of providing credentialing information to health care entities, or licensed nursing home reporting, providing information, opinion, counsel or services to a medical peer review committee, or participation in the procedures required by this section, shall not be liable in a suit for damages by reason of having furnished such information, opinion, counsel or services or by reason of such participation, provided, that such individual or institution acted in good faith and with a reasonable belief that said actions were warranted in connection with or in furtherance of the function of said committee or the procedures required by this section.

Dr. Luis Sanchez and Dr. Wayne Gavryck need to be held to the same professional standards as the rest of us.

If you can support either of them procedurally, ethically, or legally, any one of them, then I will turn in my medical license with a bow on it. If they did not commit negligent fraud by standards of care and procedural guidelines, egregious moral disengagement in violation of ALL ethical codes for the medical profession and society and break the law then disprove me. Just one will do.

But you can’t do this then I ask that you speak up and take a stand. Either defend them or help me hold them accountable. If a crime is committed it needs to be addressed. Ignoring encourages more of the same.

And if this cannot be supported procedurally, ethically or legally then I want to know what is going to be done about it?

How low does the moral compass have to go before someone takes action?

Doctors are dying across the country because of people just like this. They have set up a scaffold that removes the usual checks and balances and removed accountability. It is this institutional justice that is driving many doctors to suicide.

So the evidence is above. Either defend them or help me draw unwanted attention to this culture of bullying and abuse. So I am asking you to contemplate if what you see here is ethically, procedurally or legally sound. If you can show just one of these then I stand corrected. But if you cannot justify this on any level then I want you to help me expose this criminal enterprise. Either defend it or fight it. Silence and obfuscation are not acceptable.

As a physician-patient relationship renders drug testing “clinical” rather than “forensic” the consequences become “treatment” rather than “discipline.” And that is the real reason behind all of this. A positive “forensic” test in most employee random drug screening programs today will result in an “assessment” for substance abuse. Most EAPs allow a choice in where that assessment takes place. The model this system is based on, Physician Health Programs. do not allow choice as evaluations are mandated to “PHP-approved” assessment centers; a rigged game.A positive “clinical” test will result in the same thing under the ASAM White Paper proposal. But the assessment will be at an ASAM facility and if a Substance Use Disorder (SUD) is confirmed it will result in mandated abstinence of all substances (including alcohol) and lifelong spirituality involving 12-step recovery And by using the healthcare system as a loophole and calling this testing “clinical” rather than “forensic” the ASAM will have successfully introduced widespread testing of a variety of Laboratory Developed Tests (LDTs) of unknown validity while removing the safeguards provided by forensic testing including chain-of-custody and MRO review.

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The terms “impaired physician” and the “disruptive physician” are used as labels of deviancy. As deviants who allegedly threaten the very core of medicine (patient care) and the business of medicine (profit) they must be stopped at all costs. Belief in the seriousness of the situation justifies intolerance and unfair treatment. The evidentiary standard is lowered. Aided by a “conspiracy of silence” among doctors in which impaired colleagues are not reported necessitates identification of them by any means necessary. Increase the grand scale of the hunt.

Sociologist Stanley Cohen used the term “”moral panic” to characterize the amplification of deviance by the media, the public, and agents of social control.1 Labeled as being outside the central core values of consensual society, the deviants in the designated group are perceived as posing a threat to both the values of society and society itself. Belief in the seriousness of the situation justifies intolerance and unfair treatment of the accused. The evidentiary standard is lowered.

Howard Becker describes the role of “moral entrepreneurs,” who crusade for making and enforcing rules that benefit their own interests by bringing them to the attention of the public and those in positions of power and authority under the guise of righting a society evil. 2

And according to cultural theorist Stuart Hall, the media obtain their information from the primary definers of social…

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This infographic on workplace bullying was created by International Business Degree Guide to convey the message that workplace bullies not only hurt people, they can also hurt business–driving away good employees in their quest for control.

Adept at dissimulation, those in authority often see what the bully expressly feigns and pretends to be. Under observation by authority the bully hides his true self and often cultivates an image designed to please and impress.

Veiling truth to those in power protects the bully. Reports of abuse are disbelieved or ignored; dismissed or minimized as exaggeration; deemed a product of bellyachers and whiners. In addition to hiding his true self the bully will often tell superiors what they want to hear. The workplace bully promotes an image of loyalty, dedication and hard work to superiors and may even feign common ideals and goals. This impression management often works.

Although no reliable statistics exist, anecdotal reports suggest an alarming upsurge in physician suicide. This necessitates a reappraisal of known predisposing risk factors such as substance abuse and depression but also requires a critical examination of what external forces or vulnerabilities might be unique to doctors and how they might be involved in the descent from suicidal ideation to suicidal planning to completed suicide.

Depression and Substance Abuse Comparable to General Population

Depression and substance abuse are the two biggest risk factors for suicide. The prevalence of depression in physicians is close to that of the general population1,2 and, if one looks…

The article below was published in the now defunct magazine Gray Areas almost twenty years ago. (Vol. 4, No. 1, Spring 1995 pp. 75-77). It is not a research article but a critique of the use of polygraphy written for a general audience.

Antipolygraph.org founder George Maschke noted in 2008 that the article “makes a good introduction to the pseudoscience of polygraphy” and “the criticisms of polygraphy remain valid today.” The basic assumption of any good test is that is has construct validity; that it is actually measuring what it is purported to measure. Polygraphy is purported to detect lies but the specificity and sensitivity are about the same as a toss of a coin and has the potential to cause a great deal of harm to those who are…

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It is not wisdom but Authority that makes a law—Thomas Hobbes

In Questions of science, the authority of a thousand is not worth the humble reasoning of a single individual— Galileo Galilei

Regulatory Decisions and Public Policy

Making sound decisions about regulation calls for an understanding of the problem it is intended to solve. Legitimate policy must be based on recognized institutions and experts. Regulatory changes demand methodologically sound science and evidence-based facts arrived at through rigorous peer review and professional oversight. The science must be reliable and unbiased. Legitimate policy must be based on legitimate institutions and expert authority grounded in wisdom. Authoritative opinion needs to be assembled with facts and best available evidence guided by science and critical reasoning to best solve a particular problem and benefit the greater good.

If the information regulatory agencies rely on to make regulatory decisions and public policy is unreliable then bad decisions, wrong decisions and flawed public policy are inevitable. Consequences can be far-reaching and grave.

The impact of the close alliance between state medical boards and their state physician health programs (PHPs) and their national organizations on this failure to achieve the public goals with which they have been tasked has not been considered. It needs to be as the consequences of relying on this illegitimate and irrational authority have indeed been far-reaching and grave. Some of the nonsense pushed forth by the PHP movement and given “regulatory sanctification” by state medical boards is beyond belief. It would be comical if the results were not so tragic.

State Medical Boards

A physician’s right to practice medicine is granted by the state medical board in the form of a medical license. Each state has a medical practice act that defines the practice of medicine and used to regulate the medical profession. The medical board is empowered to identify and take action against doctors for substandard care, unprofessional behavior and other violations as defined by the state medical practice act. Given that medical boards are state agencies, their authority is subject to traditional constitutional constraints including equal protection and procedural due process limitations.

State Medical Boards have faced criticisms for being lax in their duty to protect the public from dangerous doctors.1,2 A recent study in the New England Journal of Medicine found that just 1% of physicians accounted for 32% of paid malpractice claims.3 One physician had at least 31 malpractice totaling more than $10 million in damages and nine of those payments were related to “failure to use proper aseptic technique” while another had at least 21 malpractice payments including eight improperly performed surgeries, three unnecessary surgeries and two surgeries on the wrong body part. Neither of these doctors faced disciplinary action from their state medical board.

Failing to recognize the germ theory by failing to meet even the most basic standards of cleanliness and wrong-side surgery are egregious. The fact that these are not isolated one-offs but repeat offenders is reprehensible. There is clearly something wrong with a system that allows such unfettered idiocy to flourish.

On the other hand there are increasing reports of excellent doctors with no history of malpractice or patient harm losing their licenses after one-offs, minor infractions or nothing at all.

The public’s goals would be better served if boards exercised their discretion against physicians who violate the most basic standards of professionalism and competency. They are failing to achieve this task.

The Federation of State Medical Boards (FSMB)

The Federation of State Medical Boards (FSMB) is a national not-for profit organization that gives guidance to state medical boards through public policy development and recommendations on issues pertinent to medical regulation.

Shortly after its founding in 1912, the Federation of State Medical Boards began publishing a quarterly journal addressing issues relating to medical licensing and regulation of doctors. First published in 1913 as the Quarterly of the Federation of State Boards of the United States, the publication has undergone several name changes and publication schedules. The archival organization and availability of full articles published sequentially over the past century is historically invaluable as it provides not only the regulatory by the national organization involved in the medical licensing and regulation of doctors and this archival organization facilitates an unskewed and impartial examination in its historical context. A focus on sound decision-making can be seen in the regulatory and legal medicine literature up until the 1990s.

For example when drug-testing was first introduced questions of validity became a genuine topic of concern.

By the late 1980s almost every state medical board was utilizing random drug and alcohol testing. Noting that “not all testing methods and results are created equal,” South Carolina State Board of Medical Examiners executive director Stephen S. Seeling, J.D. addressed the critical importance of accuracy and reliability in the Federation Bulletin in 1988 and cautioned that “if boards wish to be able to use positive results of drug screens in administrative or legal proceedings, great care must be taken to insure that the results are accurate, reliable and thus legally probative.” 4 Suggesting that board members and board attorneys be familiar with specific testing methodologies Seeling concludes that:

Random drug testing is an important tool for every board in its mission to protect the public and maintain the integrity of the medical profession. Careful attention however must be given to this process to insure the reliability and legal defensibility of testing results. Failure to do so could diminish the board’s credibility in the eyes of the profession and the public, and expose the board to potentially serious legal challenges.”4

This sound decision-making unfortunately took a nasty left turn in 1995. In that year the Federation of State Physician Health Programs (FSPHP) forged a relationship with the Federation of State Medical Boards. They have been going strong ever since.

1995 FSPHP/FSMB Alliance

The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence, published in JAMA in 1973,5 recommended that state medical societies establish programs to identify and treat “impaired physicians” which the AMA defined as “a physician who is unable to practice medicine with reasonable skill and safety to patients because of mental illness or excessive use or abuse of drugs, including alcohol.”

Physician Health Programs (PHPs) were subsequently developed to assist with the goal of rehabilitating and monitoring doctors as an alternative to disciplinary action by state medical boards. Preferring rehabilitation to probation or license revocation so long as the public was protected from imminent danger, most medical boards accepted the concept with support and referrals.

PHPs existed in almost ever state by 1980. Often staffed by volunteer physicians and funded by the state medical society, these programs served the dual purpose of helping sick doctors and protecting the public. As an alternative to disciplinary action these programs advocated for physicians who developed illness, assured they got proper treatment and provided monitoring to assure they remained healthy. The mechanics and mentality of PHPs were initially quite variable.

The model used today came out of the “impaired physician movement,” which according to British sociologist G. V. Stimson is “characterized by a number of evangelical recovered alcoholic and addict physicians, whose recovery has been accompanied by an involvement in medical society and treatment programs. Their ability to make authoritative pronouncements on physician impairment is based on their own claim to insider’s knowledge.”6

In 1987, the Atlanta Journal and Constitution ran a series of reports after five patients in the “Impaired Professionals” program at Ridgeview Institute created by G. Douglas Talbott in Atlanta killed themselves7 and least 20 more died by suicide after leaving Ridgeview.8 It was reported doctors were coerced into Ridgeview and then threatened and bullied to comply with any and all demands under threat of loss of licensure. All patients were indoctrinated into A.A. and forced to confess they were alcoholics or addicts or threatened with expulsion and with not being certified or advocated for with their Medical Boards.

A “recovering” alcoholic and addict who had previously been a successful cardiologist Talbott created the DeKalb County Impaired Physicians Committee for the Medical Association of Georgia in 1975 and subsequently founded the Georgia Disabled Doctors Program for the assessment and treatment of physicians, in part because “traditional one-month treatment programs are inadequate for disabled doctors.” He created the “Impaired Professionals” program at Ridgeview to provide this specialized treatment. The Constitution reported that doctors entered the program under “threats of loss of licensure even when they would prefer treatment that is cheaper and closer to home,” 9 because Ridgeview “enjoys unparalleled connections with many local and state medical societies that work with troubled doctors,” and “licensing boards often seek recommendations from such groups in devising an approved treatment plan”

The Constitution reported that those in charge of the program are often “physicians who themselves have successfully completed Ridgeview’s program.”9The impaired physician movement emphasizes disease and therapy, rather than discipline and punishment. They believe that alcoholism and addiction is a chronic relapsing brain disease requiring lifelong abstinence and 12-step spiritual recovery. The drug or alcohol abuser or addict is a person lacking adequate internal controls over his behavior and for his own protection as well as the protection of society external restraints are required including involuntary treatment.

“Contingency-management,” or systematic use of reinforcement is a type of treatment used in the mental health field in which patient’s behaviors are rewarded (or less often punished). It has successfully been used in substance abuse treatment by using prizes or vouchers for positive reinforcement by, for example giving prizes or vouchers for negative drug screens or following up for an appointment.10,11. At Ridgeview, a doctor’s medical license was being used as the leverage. This is not contingency management. It is extortion.

Many addiction professionals were highly critical of Talbott’s methods, including LeClair Bissell.7 and Assistant Surgeon General John C. Duffy who said that Ridgeview suffered from a “boot-camp mentality” toward physicians under their care.”8 “”

Talbott justified this length of stay because he claimed doctors were unique because of what he calls the “four-MDs,” ”M-Deity”, “Massive Denial” “Militant Defensiveness” and “More Drugs.”12

The cost of a 28 day program at Ridgeview was $10,000 but far more for the thrice lengthy stay required by healthcare professionals..8 I would say the impetus behind this is due to just “two-MDs,” “Medical License,” and “More Money.”

A jury awarded $1.3 million to the widow of one of the deceased physicians against Ridgeview,13 and other lawsuits initiated on behalf of suicides were settled out of court, but nothing else has changed.14

These suicides did not generate any reaction from the medical community at large and any doctor referred by a PHP for an assessment today will spend at least 3 months in treatment. ” It is inevitable. The Dicto simpliciter argument of “terminal uniqueness” has been cemented as in 1995 this PHP model won the lottery. A 1995 issue of The Federal Bulletin: The Journal of Medical Licensure and Discipline, published by the Federation of State Medical Boards, contains articles outlining PHP programs in 8 separate states. Although these articles were little more than descriptive promotional pieces written by state PHP program directors with no described study-design or methodology the journals Editor proclaimed “the success rate of the programs and others like them approach 90%.” 15 and “cooperation and communication between the medical boards and the physician health programs must occur in an effort to protect the public while assisting impaired physicians in their recovery.” 15 The 8 state PHPs were all based on Talbott’s methodology.

Nonsense such as the “four-MDs” and thrice lengthy treatment has been accepted without scrutiny. Logical fallacy is written as science. For example Merlo and Gold use the “appeal to consequences” logical fallacy to justify the extended length of stay stating that “physicians with a substance use disorder are not typical of addicts in general, it is not useful to apply standard professional guidelines… Rather, because of the public health consequences of relapse, most physicians who are addicted are treated more aggressively and for longer periods” than non-physicians.

According to Merlo and Gold “Physicians will lobby for a level of care that minimizes the disruption of their daily life. However, it is generally not advisable to grant the physician’s request for treatment in the least restrictive environment, but rather to maximize the treatment dose and duration to improve effectiveness and reduce the likelihood of relapse and further damage to health, family, and the ability to practice. Depending on the response to treatment, physicians typically undergo 3 to 6 months of intensive treatment in a structured program and 5 years of urine testing with controlled, contingency-managed outpatient follow-up.16 This gibberish has no basis in reality. It is made up out of whole cloth. No evidence-base exists and it is propaganda based fear that defies not only reason but common sense.

The Federation of State Medical Boards House of Delegates adopted an updated Policy on Physician Impairment at their 2011 annual meeting approved the concept of “potentially impairing illness.”

According to the Federation of State Physician Health Programs …”physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.”

“Process addiction” was added as a potentially impairing illness including compulsive gambling, compulsive spending, compulsive video gaming, and “workaholism.” According to the FSPHP “the presence of a process addiction can be problematic or even impairing in itself, and it can contribute to relapse of a physician in recovery. As such, process addictions should be identified and treated.” They define three levels of relapse. “Relapse without use” is a 12-step concept. G. Douglas Talbott defines it as “stinkin thinkin.”

According to Judith Eaton of the Massachusetts PHP, Physician Health Services, Inc. (PHS), not having “complete, accurate, and up-to-date records” could be a red flag for such a potentially impairing illness as “when something so necessary is not getting done, it is prudent to explore what else might be going on.”

The FSMB and state medical boards have gone on to condone polygraph testing and non-validated neuropsychological testing pseudoscience in their “disruptive physician” exams. Is the magic 8 ball and tea leaves next? How low does the credibility compass have to go before someone stands up and calls bullshit on this carnival? The most egregious of indiscretions has been the introduction and acceptance of junk-science.

“Medical Sanctification of Junk-science”

Those behind the Inquisition knew they did not have to convince everyone to get what they wanted, just Ecclesiastical and political authority. The same applies here. Ethyl Glucuronide (EtG) was introduced in 1999 as a biomarker for alcohol consumption,17 and subsequently suggested as a tool to monitor health professionals by Dr. Gregory Skipper because of its high sensitivity to ethanol ingestion.

What is so egregious about this is there was absolutely no evidence base. Skipper, who was convicted of a felony in Oregon and had his licenser revoked but got it back by claiming he was redeemed through A.A. read about it and after a study on just 14 patients pitched it to a drug testing company as a Laboratory Developed Test (LDT). The LDT pathway is a shortcut to get lab tests approved (under the premise that it will be used in treating a person medically and is thus of benefit) but Skipper took advantage of this loophole to develop a “forensic” LDT. He then used his position as the Alabama PHP Director to pitch it to the Medical Board before the ink dried.

As an LDT the FDA has no control over advertising so the lab can make any claims they want and in this case they claimed a positive EtG (> 100) was definitive proof of drinking. The State PHPs started using them on physicians. As PHPs were using them, the labs were able to sell it to other groups seeing they were “medically sanctified.” The test was subsequently found to be so sensitive that it could measure incidental exposure to alcohol in foods, over the counter cold medications, mouthwash18,19, hand sanitizer gel20, and nonalcoholic wine.21 Sauerkraut and bananas have even been shown to cause positive EtG levels.

After a Wall Street Journal Article came out debunking the test most monitoring programs abandoned it. PHPs did not. Talbott puts out a list of literally hundreds of products doctors need to avoid including colognes, mouthwashes, and foods.

Skipper simply kept raising the cutoff point from 100 to 250 to 500. It is now known hand sanitizer alone can cause a level of 2000. He subsequently introduced other tests as confirmatory tests.

Many people had licenses revoked, loss of custody of their children, went back to jail, and suffered multiple other losses. If you look at the evidence base it is absent. There is nothing. The emperor has not clothes. This is a racket and the damage has been grave.

These same people are trying to sell the “PHP-blueprint” and its array of non-validated test to other populations as the “new paradigm” just as they did with the snake oil tests. The same carney hucksters are promoting the whole enchilada as a package deal. In “Six lessons from state physician health programs to promote long-term recovery” Robert Dupont and Dr. Greg Skipper attribute a high success rate to the following factors:22

(1) Zero tolerance for any use of alcohol and other drugs;

(2) Thorough evaluation and patient-focused care;

(3) Prolonged, frequent random testing for both alcohol and other drugs;

(4) Effective use of leverage;

(5) Defining and managing relapses; and

(6) The goal of lifelong recovery rooted in the 12-Step fellowships.22

Caveat emptor people. Caveat emptor! Any argument should be based on its own merits and methodology and evidence must be examined to discern its validity. Hopefully other agencies will look at this with a more jaundiced eye and less obtusity than the FSMB and state medical boards.

Unfortunately the position of the regulatory agencies towards this illegitimate authority and irrational authority has been one of uncritical acceptance and blind faith. It is the absence of objective assessment and critical analysis that has enabled the FSPHP and PHPs to gain tremendous sway in the medical profession and cause tremendous harm to the medical profession. By confusing ideological opinions with professional knowledge the medical boards have rubber stamped whatever’s been thrown their way and for this they should be ashamed. The impact of this close alliance between state medical boards and their state physician health programs (PHPs) and their national organizations on the current state of medicine has not been examined. It needs to be.

Galusha BL. Quality initiatives. The role of medical licensing and disciplinary boards. Quality assurance and utilization review : official journal of the American College of Utilization Review Physicians. Aug 1988;3(3):66-70.

Like this:

Chain-of-Custody refers to the document or paper trail showing the collection, control, transfer, analysis and disposition of laboratory tests. It is the written documentation of a specimen from the moment of collection to the final destination to the review and reporting of the final results. The multi-part chain-of-custody form, or “custody and control” form, is part and parcel of this process. It contains stickers to sign and seal the specimen so that it cannot be tampered with and the form itself is signed by the appropriate parties as the test specimen travels from place to place. Information is added to the form as it travels from person to person. It has been given the status of a legal document as it has the ability to invalidate a specimen with incomplete information. Once the sample is analyzed it is reviewed by a Medical Review Officer (MRO) for final review. In the case of a positive test it is the responsibility of the MRO to ascertain an intact chain-of-custody, determine whether an alternative explanation exists for the positive test such as a prescribed medication, and then and only then report the test as a “true positive.”

The MRO looks for what are called “fatal flaws” and, should one be present, invalidates the test. A fatal flaw requires the test be rejected as it were never drawn. It invalidates it and it cannot be used.

Forensic versus Clinical Drug Testing

Forensic drug testing is done for medico-legal purposes. It is used for testing people for substances of abuse or substances in those who should not be using them. Forensic drug testing results in consequences. These consequences can be grave and far-reaching if the drug-testing is being done by a regulatory agency or some other body given the power to sanction or punish. Loss of careers, of child-custody, and of rights and freedoms can all depend on results of a single test.

Random drug-testing done in the workplace is also forensic but the consequences are usually quite different. A positive drug-test done in this manner typically results in an assessment, treatment if indicated, and compliance with some sort of monitoring protocol in order to return to work.

Forensic drug testing follows more stringent guidelines than clinical testing because of these consequences. Some are more stringent than others, requiring split-specimen samples and the use of only certified labs. But the minimum requirements for any and all drug testing include strict chain-of-custody procedures and review by a certified MRO.

Clinical drug testing, on the other hand, occurs in the course of a doctor caring for a patient. It is done to diagnose and treat and cannot be used outside this purview. The results of a clinical test are part of the medical record and deemed ‘Protected Health Information’ (PHI). The results are protected by HIPPA and cannot be disclosed to anyone not directly involved in your direct medical care without your written consent. There are no additional guidelines in place for clinical drug-testing as patient autonomy is preserved. A positive result could result in a recommended course of action by the physician but it is still up to the patient whether or not to follow that recommendation. It is not imposed. But there are some groups who want to change that by blurring the lines between “forensic” and “clinical” drug testing.

The ASAM White Paper on Drug Testing

According to the ASAM White Paper on Drug Testing, clinical drug-testing “employs the same sound procedures, safeguard, and systems of information management that are used for all other health-related laboratory tests, tests on which life-and-death medical decisions are commonly made.” In the box above they describe the multiple safeguards in place and requirements demanded of “forensic” drug testing, but do not mention the reason these uncompromising and multiple specifications exist is to protect the donor from a false accusation of drug or alcohol use. They proceed to define “clinical drug testing” as “part of a patient examination performed for the purposes of diagnosis, treatment, and the promotion of long-term recovery”, noting that clinical testing “must meet the established standards of medical practice and benefit the therapeutic relationship, rather than meeting the formal legal requirements of forensic testing.” The authors then state that the “majority of drug testing done today” includes both forensic and clinical elements, using individuals on parole and probation as examples.

The logical fallacy here is striking. It is comparing apples and oranges. After detailing the specific quality-assurance safeguards designed to prevent the donor of a drug or alcohol test from being falsely accused of illicit use, the authors give a general definition and purpose of “clinical” testing then state that when testing for drugs the systems in place are up to snuff as it is already being used to make life-and-death medical decisions. The take-home message is that “forensic” testing is unnecessary hyperbole designed for legal challenges. The clinical lab systems in place are used for critically important testing so it can be used for drug-testing. After all, parolees and probationers don’t require it.

Forensic guidelines developed in collaboration with occupational and environmental medicine specialist, clinical and forensic toxicologists, pathologists and others, and each of these requirements exists to assure the validity and accuracy of the testing process and protect the donor. If “clinical” testing context had fit the bill then “forensic” testing would not have evolved. Labs ordered clinically in the course of patient care are interpreted within the context of multiple other pieces of data. Lab errors occur all the time and are interpreted in that context.

Oftentimes a lab will not fit with the clinical picture and, when that happens, a repeat lab is ordered for verification. Specimens get collected in the wrong tube and specimens get lost but in the clinical setting they simply get reordered and there are no consequences to patient care. In contrast drug testing is an all-or-none one-shot test and the results have consequences. It is for that reason they must be valid.

Chain-of-custody and MRO review are critical and that is why most drug-testing programs follow the forensic protocol. And the example of non-forensic drug-testing parolees and probationers is misleading. Any Employee Assistance Program that has a union or some other group looking out for their best interests uses strict “forensic” guidelines. Parolees and probationers have no power and have no choice. Besides, the National Association of Drug Court Professionals uses the Laboratory Developed Tests these same people introduced to test individuals on probation or parole in the criminal justice system just as they do in the PHPs.

The ASAM White Paper:

“Encourages wider and ‘smarter’ use of drug testing within the practice of medicine and, beyond that, broadly within American society. Smarter drug testing means increased use of random testing* rather than the more common scheduled testing,* and it means testing not only urine but also other matrices such as blood, oral fluid (saliva), hair, nails, sweat and breath when those matrices match the intended assessment process.

In addition, smarter testing means testing based upon clinical indication for a broad and rotating panel of drugs.”